You need to know about a deadly danger lurking out there. You need to know if you drive a car, take a bus, walk, or fly in an airplane. You need to know if you date, or go out into the public for food and/or drink. You need to know if you take health food supplements, and if you have ever taken or considered taking an over-the-counter sleep aid. You need to know if you work out and try the sports enhancing supplements. You really need to know if you are a parent of a child 12 years of age or older. You need to know if you have an “addictive personality.” You need to know if you manage a mandatory or random drug-testing program (because this drug is NOT being picked up by your drug screen).

And, you need to know about it if you are a medical professional working in an emergency room or specializing in addiction treatment.

What single thing could possibly be so all pervasive and dangerous?
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What is "IT?"

“It” is a highly impairing drug that has become epidemic across the country, is still a virtual mystery to law enforcement and the public, and presents a tremendous threat to life itself. No drug has ever spread so far and wide and so silently. It is clear and virtually odorless, and its somewhat salty taste is rather easily masked by fruity, multi-flavored drinks or simply masked by the explanation that it is a workout or sleep aid.

“It” is gamma hydroxy butyrate (GHB) and/or its analogs (chemical cousins which have the same effect). GHB is known by names like G, Liquid Ecstasy, GHBeers, Grievous Bodily Harm, Scoop, Jib, GH Buddy, Easy lay, and Sodium Oxybate. The analog products—sold under an ever-changing series of names—continue to pop up in “health food” stores and are available for order through the Internet. They are dangerous and illegal (legal status varies from state to state; they are federally unapproved drugs by the FDA and federal control as a Schedule I drug is pending).

What you need to know, for your personal safety and the safety of your family, is that GHB is distributed by the capful (typically from a common water bottle, mouthwash bottle or literally any container that will hold a liquid) or by the “sip.” It is usually a liquid, but may also be seen in powder, capsule or even a “putty-like” form. It can be easily slipped into someone’s drink (with an eyedropper, poured from a small bottle or squirted out of an eye medicine bottle, for example). Females will often be talked into trying some unusual, unfamiliar drink.

GHB is commonly known as the “date rape drug,” and it is has truly forever changed the investigation of sexual assaults. GHB is in the blood approximately only four to six hours and then in urine only about 12 hours. It is NOT detected in any standard drug screen; in fact, at this point, there is no field test kit to help police officers identify it. Gradually, crime labs and private testing labs are getting on board with the ability to test for GHB and its analogs as a product or in biological samples. Because of the giddy, high level of intoxication it causes and the fact that it seems to stimulate sexually oriented behavior, victims are often ignored by the police or depicted by witnesses as having been very drunk and “willing” in behavior. The memory loss adds to the problems of investigation and prosecution.
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Statistics - Underreported

But, GHB is also very widely, voluntarily abused by individuals from 12 to 77. It is common in the high school and college party scene and in the gym crowd (including high school or college athletes and cheerleaders) and the pricey nightclub scene. It may also be taken innocently by individuals who were told that GHB is a “safe” sleep aid or a diet aid that will allow you to get “high” without the calories and hangover of alcohol or develop lean muscle mass. Individuals who work out should be careful of all supplements being sold as a steroid enhancer, weight loss product, sleep aid, etc., in the stores or in the parking lots at places like Max Muscle, Golds Gyms, Powerhouse Gyms, GNC, etc. and over the Internet. Each person needs to be careful not to be tricked into taking GHB or an analog product. In December 1999, Phoenix Suns player Tom Gugliotta took a GHB analog product as a sleep aid and the second time experienced a seizure and stopped breathing. It is 1) Declared by the FDA to be an unapproved drug, 2) Banned by U.S. Customs for import and specifically controlled and illegal in at least 26 states (and federal legislation will take effect soon) and 3) dangerous to your health.

More than 5,800 overdoses have been documented in emergency rooms nationwide and more than 66 deaths (more than 12 of them in 1999) are now considered GHB-related, according to the Drug Enforcement Administration. There are more than 40 other deaths (nearly all in 1999) being reviewed by the DEA at this time. This means the death rate more than doubled in 1999 and several have died already in the year 2000. Experts agree that this is likely just the tip of the iceberg since neither law enforcement nor medical examiners have known enough about it to recognize it in many cases. Results of a UCLA survey of GHB users indicated that although 67 percent reported loss of consciousness, only seven percent had gone to the ER. If that statistic is at all representative, then the 5,800 cases reported by ERs may reflect only seven percent of actual overdoses.
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Effects - Unpredictable

Little is known about how GHB works and especially how it selects its victims. It is extremely dose sensitive and very unpredictable (no matter what the “quality” of the product). Users, especially beginners or the unsuspecting victims, often vomit and experience body jerking. They may lose control of bodily functions or wet themselves during the night, unable to wake up and go to the bathroom. They may pass out (called “carpeting out” or “throwing down” among the ravers and club goers) and, while most “sleep it off,” the unconscious state is risky. For those taking lighter doses, there may be incidents of the “head snap,” when GHB takes effect. One user described the head snap as an involuntary snap forward of the head; brief but dangerous. He had experienced this while brushing his teeth and had broken mirrors with his forehead on occasion. Another addict reported the same sensation and indicated he had broken several sets of glasses from the head snap. Breathing may slow to as few as six breathes per minute. They cannot hear phones ringing, horns blaring, fire alarms, etc. At some point, the individual may be without a protective “gag” reflex, allowing death to come easy. Others have been killed by those driving under the influence of GHB or GHB/alcohol.

A victim can die from direct effects of the drug, simply forgetting to keep breathing, having seizures that block the airway. A person in a GHB coma left lying on his (or her) back with gum in the mouth could die simply because the gum happened to fall into a position blocking the airway (it has happened). A person can go into a GHB coma while sitting in the bathtub and simply slide down into the water and drown without even a whimper (it has happened). A user can die from simply taking a dose, as directed for a sleep aid, and going to bed, face down on a pillow. There is no “safe, responsible” use level.

GHB is commonly listed as a central nervous system (CNS) depressant, but may really belong in a class of its own. It produces symptoms somewhat similar to alcohol intoxication in general, but with a few twists of its own. Extreme cases of intoxication will appear similar to PCP. For example, a young man in Los Angeles, unknowingly dosed with GHB in a Hollywood club, ran through the club, grabbing women’s breasts and was thrown out. He ran from the location, tearing off his shirt (common to PCP users), screaming that the world was coming to an end and that he was on fire. Somehow he climbed on top of a Burger King restaurant and held LAPD SWAT officers at bay for two hours, hurling cans of paints and other objects from the rooftop. He was ultimately knocked down with a beanbag round. Four hours after taking the drink, the episode ended suddenly. He had no recall of what he had done.

Club owners often recognize that this is a “new” drug when it hits their facility. Common indicators that GHB has indeed arrived include:

--increase in rapes (typically noted via the rape treatment centers—but commonly

unreported to police) and,

--sudden increase in problems at the location (more disturbance calls, vomit in the

bathrooms and hallways, etc., little vials left lying around, rapid onset of intoxication, increased aggressive and/or sexually oriented behavior by patrons, increased drunk driving around the location but with surprisingly low blood alcohol levels, unarousable “drunks” inside and outside the location, etc.).

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Addiction Nightmare

Forget the Internet babble that GHB is not addictive. Those who become addicted are in serious trouble, as detoxification from GHB is difficult and even life threatening. Bodybuilders are the ones more likely to become addicted since they are most likely to take it on a regular basis, while partygoers “may” last longer with just occasional use.

Several months ago I got to know a man who had been addicted to GHB for eight years. A former bodybuilder (who even modeled workout clothing with some awesome abs) and a contractor, GHB had taken over his life. His ability to discipline himself and work out was long gone. His body was clearly that of an EX-body builder. When I interviewed him on camera for French TV, he struggled to stay focused and finish sentences, something he attributed to the prolonged abuse of GHB. He'd lose his train of thought and in frustration say, "Trinka, I'm telling you. I wasn't like this. It's the GHB." He was working as a contractor on a small scale. His marriage was falling apart.

I had met him through a doctor at UCLA (Dr. Karen Miotto) who was studying GHB, and interviewing users around the campus. She had introduced me to Dave and was planning to help him detox, but UCLA, like most facilities, had little exposure to the withdrawal syndrome from GHB. After talking with other GHB experts (and learning that it's more likely a 10-14 day, intensive care situation than the usual 3-5 day detox), they proceeded with his detox---and what an experience it was for them all. By the time he actually went into the hospital, he had gotten even more confused and frustrated. He would somehow remember or be able to find my phone number, but would lose the UCLA phone numbers. He would call me, asking for his doctor's number (remember--he knew HER before meeting ME). About eight to ten days later, he would call me again, asking for her number and oblivious to the prior conversation. Sometimes he remembered his doctor's name and sometimes he didn't. This happened three or four times. His wife had given up on him and was ready to leave; her three children didn't need any more of this mess.

Then one day I got a call that he was in the hospital in detox. They were in Day 4, and the doctors were worried. He was experiencing bizarre episodes, despite heavy medication, and they were actually worried that he might not live through it. He did survive. Detox took 12 days plus psychiatric care follow up. For UCLA Doctor Karen Miotto it the worst drug withdrawal she had seen. His experience--which he does not remember at all--is the subject of a paper that will be published soon.

The doctor had told me he was doing well and working at getting his life back together and back to work. Then she lost contact with him. We both left messages for him and got no replies. The various numbers did or didn't work from time to time, but we weren't making contact. Some of the numbers were disconnected. We really became concerned as the weeks passed that he had either started using again and didn't want to admit it to us---or worse. Frankly, I was ready to call the LA Coroner's Office to check. But a couple of days ago I ran across his number in an old note and called it one more time, just in case. To my amazement, his wife answered. Yes, he was still alive, and yes, they are still together. He's doing well, but just busy. She was thrilled to have her husband and father of her kids back. Later he called, and what a difference. This wasn't the fuzzed, disorganized conversation of the past. This was a man with clarity and life, back among the living. He said his body still needs some "reconstruction" to see those washboard abs again, but he's on his way.

Not everyone will have such a tough time in detox, but neither is his experience that unusual. During the past few months I've learned a lot about a couple of young men who were addicted to GHB, lived several months of hell trying to escape from it and paid the ultimate price, overdosing on other drugs trying to stay off the G.
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GHB Withdrawal is Life-Endangering

Joshua

Josh in Northern California and Matt in Pittsburgh, Pennsylvania, didn't make it. For months their frantic mothers went with them from ER to ER and treatment facility to treatment facility, pleading for help for their sons and waving bottles of GHB analog products. No one seemed to comprehend the severity of the battle. No one had the right answers to their quest for relief from GHB addiction. Three- to five-day detox and out the door is NOT the answer to a GHB addiction.

From March 1999 until his death July 4, 1999, Myrna Parks struggled to help him. He resisted help at first, buying into the nonsense of the GHB gurus of the internet that GHB is totally safe. “Mom, it can’t be bad for me. I bought it at a health food store.” By March of 1999 when Josh came home to live with his folks, he was sick. He had lost ten pounds in just four days and his saliva glands were no longer working. He had severe diarrhea, vomiting and a white ring around his mouth. He was unable to sleep with body tremors and a high pulse rate. She describes the ambulance run this way, “He became rigid, unable to sit or talk. We could not lay him down in the ambulance because he had lost the ability to swallow his own saliva and began to choke on it. He had to leave him sitting up so that he could drool down his chest. His eye would roll to the back of his head. He could not follow commands, hold or squeeze my hand. He was in a complete vegetative state. I prayed. I couldn’t let go.” Somehow Josh survived that day.

Still, he was angry when his mother rushed him to the ER. She had overreacted as far as he was concerned. Remember, the internet gurus say not to call 911, not to take anyone to the ER; just let them sleep it off. That is potentially deadly advice in a GHB overdose and certainly not helpful to the person in withdrawal from GHB, for whom sleep does not come for days. GHB withdrawal is now known to be life endangering.

This was but the first of many episodes for Josh in the final months of his battle. Then on July 4, 1999, Josh pleaded for something to help ease the pain and sleep. His mother urged him to try hard to sleep with just his prescribed medication and dosage. Unable to do so, Josh apparently acquired someone else’s medication and died of an overdose of a mixture of drugs, seeking only a night’s peace from the withdrawals from GHB.

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Matt

On September 1, 1999, a similar battle--18 months in duration--ended for 26-year-old Matthew Michael in Pittsburgh, the youngest of four. A registered nurse with experience in drug and alcohol rehab, Matt’s mother literally watched him die over 18 months of hell. He was hospitalized ten to 15 times during that year and a half. She advised paramedics and doctors that he had been taking Renewtrient and NRG3 (GHB analogs) to no avail. Experience with GHB was and still is limited. He struggled through numerous driving under the influence arrests. She saw him fall asleep standing up. When not on it, he endured sleeplessness, abdominal pain, rapid heart rate, soaring blood pressure, profuse sweating, tremors, eating disorder, inability to concentrate and depression. At the end, he would complete one more brief detox program, report to jail for a 72-hour lock up re a previous DUI and go home to die of multiple drugs, trying not to take GHB again.

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What Help for the Addicted?

Matt and Josh are not listed in the official GHB-related death count since their deaths were not caused directly by taking it. Yet they truly died because of GHB. Spurred on by their deaths, the www.ashesonthesea.com/ghb website posted an addiction help request line on December 23, 1999. Within one hour, the requests for help started coming in. With no fanfare or advertisement, the help request forms have been coming in at a rate of just over one per day. Their stories are so similar.

They typically were taking it as a sleep aid, or for promised muscle gain and/or weight (fat) loss, or as a way to beat a random or mandatory drug test program (because it is not picked up in the standard drug screen). At one point, nearly all would have sworn that GHB was the greatest drug on earth………until it turned on them. Many had been in denial re the problem; some still were in denial (it was friends or loved ones writing in for help). One attempted suicide while his mother was trying to convince him to get help. Fortunately, he survived and was hospitalized to get the help he needed. Marriages were falling apart. Businesses were failing behind their GHB addiction or jobs were being lost. One woman had racked up credit card debts of $12,000 to feed her addiction. Bodybuilders were now ex-bodybuilders, no longer able to keep up the discipline of a workout schedule. One woman had died from GHB twice and had been brought back by paramedics; she had been raped, but had not reported it, feeling it must have been her fault.

Most of those asking for help have gone to ER for overdose or withdrawal symptoms. Withdrawal symptoms may be mistaken for a drug overdose at the ER. Many have sought help with their addiction but were met by total disbelief from those who had never heard of GHB addiction or were turned off to the system by what they felt was inadequate treatment. Many said that they spent only three or four days in treatment and then were sent home at a point when they recognized that they needed further treatment. They said that they realized that the doctors were ill informed or had no clue at all what they were dealing with, and that they would not subject themselves to such torture again. It was very difficult to convince them that proper referrals and medical treatment were possible. It was often difficult to convince them that “weaning” oneself from GHB is virtually impossible for most people, and that home detox just won’t work.

They typically asked us to “just tell me what drugs to take and let me do it at home.” Such information was, of course, not an option. We pointed out that GHB withdrawal is life endangering. That doctors needed to monitor them and treat their condition as it changed. First the doctors would likely have to deal with racing pulse and soaring blood pressure. Then they’d have to deal with the bouts of anxiety, sleeplessness, overall pain, hallucinations, depression, etc. A 10-14 day medical detox would be the best route, according to our experts, getting the worst of it behind them. Some facilities working with GHB withdrawal sedate heavily during that 10-14 day period, allowing them to “miss” the worst of the experience. In any case, doctor supervision and immediate medical care is the key. Those who chose that path are now thankful. Those who persisted with trying to wean themselves off or doing it at home with or without doctor supervision, typically found it a much longer, tougher method and some failed. Those who confided in supportive friends or relatives fared the best. Those who faced it alone suffered the most.

Our inquiries, totaling more than 55 in the first 45 days, have come from 22 states plus two foreign countries. Their ages range from early 20’s to 44. They range from housewives to professionals. Only a few were recreational users. Most were involved with “purposeful” use. If they lived near one of the handful of experts we were working with, we referred them directly to our doctors. If not, we tried to help them locate treatment facilities and doctors capable of doing a medical detox and willing to learn. We then linked their doctors with our experts for advice. Most Poison Control Centers were very helpful in identifying medical detox facilities. Most treatment centers were helpful and willing to learn. We were shocked at those few who said they didn’t want to “be bothered” by anything new and potentially dangerous (even though they were set up to do a severe delirium tremens detox which is quite similar).

It is our hope to alert all treatment facilities and ERs to the life endangering quality of GHB withdrawal so that proper treatment will become the norm, not the exception. We also hope to alert everyone to the fact that it is often used to beat drug testing, sometimes by people in key public safety jobs.

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Analogs - Chemical Cousins

Analog product names surfacing so far have included: Blue Nitro, Renewtrient, Revivarant, Remforce, Firewater, Enliven, Serenity, ZEN, Revitalize Plus, Thunder Nectar, Weight Belt Cleaner, SomatoPro, Verve, Jolt, Eclipse, Regenerize, Remedy GH, NRG3, GHRE, GHGold and G3 (being sold in some franchise GNC stores). They may appear in any color, including clear, light amber, red or blue. Anyone driving a vehicle under the influence of these substances presents a potential safety hazard. They are used in rapes in exactly the same way GHB is used. Several of the documented GHB-related deaths involve these products.

Many of them list the main ingredient as 2(3H)-furanone di-hydro and claim that it does not contain GHB or any other illegal substance. This ingredient is simply gamma butyrolactone (GBL), the precursor of GHB, being listed by a chemical synonym. Though a precursor to GHB, it is also an active “analog” of GHB. Several of the products list the primary ingredient as 1,4 butanediol (BD) or its other chemical synonyms, tetramethylene glycol or sucol-B. These products may also surface labeled as degreasing or cleaning products that are in reality being used for human consumption. Or, the bottle (Revitalize Plus, for example) may say simply “proprietary polyhydroxyl complex, a blend of amino acid metabolites.”

Mere possession of the precursor/analog GBL or the analog 1,4 butanediol is not illegal in and of itself at this time. But, any action that converts the product to “human consumption” (such as sticking a straw in the bottle, pouring it into human consumption type water or vitamin or mouthwash bottles, or labeling it as a sleep aid or nutritional supplement, etc.) makes it an analog under California state law, for example, and thus illegal. As of January 1, 2000, GBL is a listed precursor chemical in California. Federal legislation to make GHB and its analogs a federal Schedule I drug passed in January 2000 and will take effect in a couple of months. An analog is a substance that has or is represented to have or is intended to have effects on the central nervous system which are substantially similar to or greater than, the controlled substance itself.

These products and similar products are also starting to appear in powder and capsule form. Some of the Internet sites promoting these products admit that there is no scientific evidence to back up the safety and beneficial effects claimed by them. Some even note that their product is being manufactured in an FDA approved lab; they further admit that this does not mean the FDA has approved the product itself. Labels notations such as “Does not contain GHB” or “legal (or herbal) GHB” are literally your first clue that the product is an analog of GHB! Most of them also foolishly discourage calling 911 when someone overdoses on these products, a deadly recommendation. When cases identify the Internet as the source of the product and when the physical location of the Internet source can be determined, prosecution may be possible either under state laws or under federal provisions through the Department of Justice, Office of Consumer Litigation.

When 15-year-old Samantha Reid died in Michigan, an innocent victim of GHB slipped into her Mountain Dew, a friend noted in despair that youth are told “daily” about the dangers of marijuana and cocaine and drugs like that, but “why didn’t you tell us about GHB?”

Now you know.

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The Doctors Who Have Been Helping Us:

NOTE: All have published on the subject of GHB and/or have manuscripts pending publication. Other doctors/clinics with experience with GHB withdrawal treatment are encouraged to contact www.ashesonthesea.com/ghb and add their names as referral resources.

Dr. Jo Ellen Dyer

Associate Clinical Professor of Pharmacy, UCSF

California Poison Control System

San Francisco General Hospital

1001 Potrero Ave Room 1E86

San Francisco CA 94110

Phone: 415 502 2058

Fax: 415 502 6060

Dr. Karen Miotto

UCLA

760 Westwood Plaza

NPI A7-384

Los Angeles CA 90024

Phone: 310 206 2782

Deborah L. Zvosec

Research Associate

Hennepin County Medical Center

Emergency Department

Minneapolis, Minnesota

Voice mail (612) 347-3963

Fax (612) 904-4470

Stephen W. Smith

Assistant Professor of Clinical Emergency Medicine

University of Minnesota School of Medicine Faculty Physician

Hennepin County Medical Center Emergency Department

Minneapolis, Minnesota

Voice mail (612) 347-3963

Fax (612) 904-4470

Drs. Alex and Janice Stalcup

New Leaf Treatment Center

2151 Salvio St. Suite T

Concord CA 94520

Phone: 800 636 8050 or 510 688 0500

Fax: 510 688 0504

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Common Chemical Names

GAMMA HYDROXY BUTYRATE (GHB)

GAMMA BUTYL LACTONE (GBL) or 2(3H)-FURANONE DI-HYDRO

1,4 BUTANEDIOL (BD) or TETRAMETHYLENE GLYCOL or SUCOL-B

NOTE: There may be other analogs that will appear.

REPORTED PRODUCT NAMES

AMINO FLEX (BD)

BLUE NITRO or BLUE NITRO VITALITY

BORAMETZ (BD)

BVM (BD)

DORMIR (BD)

ENLIVEN (BD)

FIREWATER

FX (BD)---ORANGE FX RUSH, LEMON FX DROP, CHERRY FX BOMB

GH-GOLD (May be referred to as GHG)

GAMMA G

GHRE (BD)—(GROWTH HORMONE RELEASE EXTRACT)

GH REVITALIZER

INNERG (BD)

INVIGORATE

JOLT

NRG3 (BD)--

PINE NEEDLE EXTRACT (BD)

PROMUSOL (BD)

REACTIVE

REGENERIZE

RENEWTRIENT

REMFORCE

REST-EZE

REST-Q (BD)

REVIVARANT or REVIVARANT G or REVITALIZE PLUS

SERENITY (BD)

SOMATO PRO (BD)

THUNDER

THUNDER NECTAR (BD)

WEIGHT BELT CLEANER (BD)

WHITE MAGIC (BD)

X-12

ZEN (BD)

NOTE: New names surface on a regular basis. Also, Revitalize Plus does NOT list any of the chemical names for BD, but lists only “proprietary polyhydroxyl complex.”